Effect of immediate postoperative portable radiographs on reoperation in primary total knee arthroplasty

Cost-containment strategies are of increasing importance in total knee arthroplasty (TKA). Obtaining immediate postoperative radiographs following primary TKA is common practice, but their usefulness is controversial. The goal of this study was to evaluate the effect of immediate postoperative radiographs on reoperation within 60 days, assess film quality, and determine the cost associated with these radiographs. Using a billing registry at the authors' institution, the number of TKAs performed from 2000 to 2011 was determined. Of those, the authors determined which had undergone reoperation within 60 days. They evaluated those who had immediate postoperative radiographs following their primary TKA, and determined those who had been reoperated on as a result of information obtained from these radiographs. Of 6603 patients who underwent primary TKA from 2000 to 2011, 136 (2%) underwent reoperation within the first 60 days. The causes leading to reoperation were arthrofibrosis, infection, wound-healing complications, and hematoma. Of the 136 who underwent reoperation, 76 had immediate postoperative radiographs. None of them underwent reoperation as a result of findings noted in the radiographs. Of the radiographs reviewed, only 43% were deemed adequate by predetermined criteria. The results of the current study demonstrate that these radiographs do not affect the decision for reoperations that occur within 60 days of the index procedure. Although there may be a benefit to immediate postoperative radiographs in selected clinical situations, the decision for routine use needs to be weighed in light of significant cost and limited clinical usefulness.